Home birth: what mums-to-be need to know

Justine Davies

Home birth

As a mum I have always been quite definite about the type of birth experience that I wanted to have and I was privileged to be able to avail myself of that choice.

Many other women in this same first-world country feel equally as passionate about their ideal birth choice – but unfortunately if their preferred location for the birth is their own home then their options can be limited. Accessing good-quality information about their choices can be difficult as well; after all, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) do not endorse planned homebirth, whereas the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Midwives do. If the experts can’t agree, how on earth are Mums meant to make a fully-informed choice?

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The subject of homebirthing has always been contentious in Australia and the issues of safety are likely to be thrown into sharp relief in the near future, following the tragic death of Caroline Lovell this week, who passed away in hospital following the homebirth of her second child. (It is not yet clear how the location of birth impacted her condition.)

While her passing will be the subject of a coronial investigation, it’s almost certain that – irrespective of the findings - the tragedy will reignite the (often heated) public debate around the safety of home birth.

Ironically, homebirth was the focus of RANZCOG’s most recent quarterly magazine, O & G (you can download the complete issue here) with a range of articles arguing both for and against homebirth (although fascinatingly, the magazine’s editorial committee noted that a number of experts declined to offer their opinion in writing, due to fear of social and political fallout). Across the many opinion pieces, a number of significant considerations for parents stood out, including:

It remains a woman’s right in Australia to determine what happens to her body during pregnancy and birth and most midwives and doctors value this right.

Home birth is not appropriate in high-risk situations. It really goes without saying, but no matter how strong your desire to give birth at home, the safety of your baby must always take precedence. There are no medical professionals who will knowingly allow a planned homebirth to proceed if a pregnancy is considered to be high risk.

Statistically, homebirth does carry more risk. While there are numerous studies that can be selectively quoted by either side of the debate, the RANZCOG makes the following statement: “The most recent meta-analysis of planned homebirth in Western countries indentified twelve studies of suitable quality for inclusion, providing a comparison of 34,205 planned homebirths and 20,755 planned hospital births. The overall neonatal death rate was almost three times higher for babies born without congenital abnormalities in the homebirth group.” The rates either way are still low, at 0.15% and 0.04% respectively – but it should be a consideration.

Homebirth greatly lowers your risk of intervention. According to Associate Professor of Midwifery, Hannah Dahlen, a first-time mother in Australia now has a greater chance of surgical intervention during her birth than of not having it! “This is not safe, either physically or psychologically,” she says. “It is also expensive, has many consequences and is counterproductive to optimising normal birth and healthy mothers and babies.”

It could make you happier. In a joint statement, the UK-based Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists stated that: “There is no reason why homebirth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families.” Further, that: “Overall, the literature shows that women have less pain at home and use less pharmacological pain relief, have lower levels of intervention, more autonomy and increased satisfaction.”

However - proximity to medical care makes a big difference! Even if you have ticked all the home-birth candidate boxes, the facts are that around one-third of home births are transferred to hospital either prior to during labour. As with any other form of birth, mentally allowing for and accepting the fact that it may not go according to plan will help you to deal with that fact if it occurs. And putting in place some contingency planning with your nearest hospital means that you are helping to minimise the risk of anything going wrong.

Finally, and quite importantly:

There are liability issues to be aware of. Currently, private insurers are reluctant to cover midwives with professional indemnity insurance in relation to home births. While this is not an issue for hospital-run home birthing programs (where midwives are employees of the hospital) it is significant for independent midwives and has contributed to a large decline in the last two years of the number of independent midwives who are willing to attend home births.

At the end of the day, explore your options and never be afraid to ask as many questions of your medical advisers as you need to. You will likely find that the overwhelming majority of obstetricians, midwives and general practitioners are happy to share their knowledge. As Associate Professor Dahlen explains: “It remains a woman’s right in Australia to determine what happens to her body during pregnancy and birth and most midwives and doctors value this right.”